Multi-lumen catheter with attachable hub

ABSTRACT

A method of inserting a multi-lumen catheter assembly. First, an incision is made near the area to be catheterized. The proximal portion of the multi-lumen catheter tube is then inserted into the area to be catheterized. A subcutaneous tunnel is created, and the first end of the tunnel is near the incision. The catheter tube is then routed through the subcutaneous tunnel and pulled tube through a second end of the subcutaneous tunnel. The hub body is then securely attached to the catheter tube by connecting the connection cover to the hub body by threaded engagement. In a preferred embodiment the hub body is attached to the catheter tube by backfitting the connection cover over the catheter tube. A compression sleeve is also backfit over the catheter tube. The cannulae of the hub body are inserted into the lumens of the catheter tube to create fluid communication therebetween. The connection between the cannulae and the first and the catheter tube is compressed by sliding the compression sleeve over the cannulae that have been inserted into the catheter tube.

RELATED APPLICATIONS

This application is a Continuation of application Ser. No. 10/086,033,filed Feb. 28, 2002, now U.S. Pat. No. 6,638,242, the content of whichis incorporated herein by reference in its entirety, which was acontinuation of application Ser. No. 09/769,052, filed Jan. 24, 2001,now abandoned.

FIELD OF THE INVENTION

The present invention relates generally to medical instrumentation andmore specifically to a method for inserting a multi-lumen catheter witha selectively attachable hub assembly that allows the catheter tip to beaccurately positioned prior to subcutaneous tunneling.

BACKGROUND OF THE INVENTION

Catheters, generally, are hollow, flexible tubes for insertion into abody cavity, duct, or vessel to allow the passage of fluids or distend apassageway. Catheters are often used for temporary or long-term dialysistreatment. Dialysis treatment provides for blood to be withdrawn fromthe patient, purified, and then returned to the patient. Thus, indialysis treatment, catheters are used to allow passage of a patient'sblood into and out of the patient's body. For optimal performance duringdialysis treatment, the catheter tips, both in-flow and outflow, shouldbe placed in close proximity to the heart. Typically, medical personneluse either a double lumen catheter or two single lumen catheters. Bothtypes, however, present certain deficiencies.

While double lumen catheters (e.g., U.S. Pat. No. 4,895,561) allow for asingle venous insertion of the catheter into the desired vein, doublelumen catheters typically do not provide for accuracy of catheter tipplacement. Due to differences among patients, optimal tip positionvaries from patient to patient. Non-optimal tip position maysignificantly lower flow values, resulting in less effective dialysistreatment. For current double lumen catheters, a physician must make anestimate regarding the appropriate catheter tube length prior tobeginning the procedure of catheterization. Then, a subcutaneous tunnelis made from the preferred end position of the hub assembly, namely,away from the neck of the patient in order to allow for more convenientaccess to the dialysis treatment equipment. The double lumen cathetertube is then tunneled forwardly into the patient's vein. The initialestimate and subsequent forward tunneling may result in less thanoptimal tip placement.

With the use of two independent catheters (e.g., U.S. Pat. Nos.5,776,111 and 5,624,413) the problem of tip placement is addressed. Thehub assembly of each catheter is removable from the tube and tip portionof the catheter, thereby allowing the catheter tip to be placed directlyinto the vein and advanced into the desired position. Then, the proximalend of the catheter can be reversed tunneled and trimmed to a desiredlength. Thereafter, the hub assembly is attached. Deficiencies, however,exist in this method of catheterization as well. One problem associatedwith this method is that this method requires two separate venousinsertions, namely, two tunnels and two of each accessory instrumentused for the procedure. Therefore, there is increased surgical timerequired to place two catheters, there are two wound entry sites whichdoubles the risk of post-surgical infection, and the two catheterstogether are significantly larger in diameter than one double lumencatheter.

SUMMARY OF THE INVENTION

The present invention is a method for inserting a multi-lumen catheterassembly into an area to be catheterized The multi-lumen catheterassembly is comprised of (a) a multi-lumen catheter tube with a distalportion and a proximal portion, the catheter tube having a first lumenand a second lumen, (b) an attachable hub assembly, the hub assemblyhaving a (i) a hub body with a distal portion and a proximal portion,the proximal portion of the hub body being externally threaded, the hubbody being formed about a first cannula and a second cannula, each ofthe cannula having a proximal portion and a distal portion, (ii) aconnection cover having a proximal portion and a distal portion, theconnection cover fitting axially about the distal portion of thecatheter tube, the distal portion of the connection cover beinginternally threaded, and (iii) a compression sleeve, the compressionsleeve fitting axially about the distal portion of the catheter tube andthe proximal portions of the first and second cannulae. The first lumenand the first cannula each have first indicator associated therewith,and the second lumen and the second cannula each have a second indicatorassociated therewith The method comprising the steps of making anincision near the area to be catheterized; inserting the proximalportion of the multi-lumen catheter tube into the area to becatheterized; creating a subcutaneous tunnel, wherein a first end of thesubcutaneous tunnel is the incision near the area to be catheterized;routing the distal portion of the catheter tube through the subcutaneoustunnel beginning at the first end and exiting through a second end ofthe subcutaneous tunnel; and attaching the proximal portion of the hubbody to the distal portion of the catheter tube.

The step of attaching the hub body to the catheter tube is furthercomprised of the steps of backfitting the connection cover over thedistal portion of the catheter tube; backfitting the compression sleeveover the distal portion of the catheter tube; matching the firstindicator associated with the first lumen with the first indicatorassociated with the first cannula, and inserting the proximal portion ofthe first cannula into the first lumen of the distal portion of thecatheter tube, to create fluid communication between the first cannulaand the first lumen; and matching the second indicator associated withthe second lumen with the second indicator associated with the secondcannula, and inserting the proximal portion of the second cannula intothe second lumen of the distal portion of the catheter tube, to createfluid communication between the second cannula and the second lumen;compressing the connection between the first and second cannulae and thefirst and second lumens of the catheter tube by sliding the compressionsleeve over the proximal portion of the first and second cannulae thathave been inserted into the first and second lumens of the distalportion of the catheter tube, and connecting the distal portion of theconnection cover to the proximal portion of the hub body by turning theconnection cover so that the female threaded portion of the connectioncover engages the male threaded portion of the hub body, such that thecatheter tube is securely attached to the hub body.

These and other aspects of the present invention as disclosed hereinwill become apparent to those skilled in the art after a reading of thefollowing description of the preferred embodiments and drawings. Thedescription and drawings are for the purpose of describing a preferredembodiment of the invention and are not intended to limit the presentinvention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an exploded, perspective view of a multi-lumen catheterassembly implanted according to the method of the present invention;

FIG. 2 is an enlarged, exploded, perspective view of a hub assembly ofthe multi-lumen catheter assembly of FIG. 1, including a firstcross-sectional view of the hub body;

FIG. 3 is an enlarged, exploded, perspective view of the hub assemblyand distal portion of the catheter tube of FIG. 1, including the firstcross-sectional view of the hub body;

FIG. 4 is a first cross-sectional view of the catheter tube of themulti-lumen catheter of the present invention;

FIG. 5 is an enlarged perspective view of the catheter tube of thepresent invention;

FIG. 6 is a perspective view of an assembled multi-lumen catheterassembly of the present invention; and

FIG. 7 is a block diagram illustrating a method of inserting amulti-lumen catheter with an attachable hub of the present invention.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

As shown in the Figures, the present invention is a multi-lumen catheterassembly 10 having a selectively attachable hub assembly 20. As shown inFIG. 1, a multi-lumen catheter tube 12 is formed with a proximal portion12 a and a distal portion 12 b. The distal portion 12 b of the cathetertube 12 is selectively attachable to the proximal portion 20 a of thehub assembly 20. In this manner, the hub assembly 20 may be attached tothe catheter tube 12 after insertion of the proximal portion 12 a of thecatheter tube, including tips 14 and 16, into a patient.

As illustrated in FIG. 2, preferably, the hub assembly 20 has a firstcannula 22 and a second cannula 24. Each of the cannulae has a proximalportion 22 a and 24 a, respectively, and a distal portion 22 b and 24 b,respectively. Further, each cannulae 22 and 24 has an associatedextension tube, 26 and 28 respectively. Each of the extension tubes 26and 28 has a proximal portion 26 a and 28 a, respectively, and a distalportion 26 b and 28 b, respectively. Each of the extension tubes 26 and28 are in fluid communication with the first cannula 22 and secondcannula 24, respectively, through appropriate connection of respectiveproximal and distal portions, namely connection of the cannulae distalportions 22 b and 24 b with extension tube proximal portions 26 a and 28a, respectively. While the drawings depict the hub assembly with twocannulae, any appropriate configuration and number of cannulae should beconsidered within the scope of the present invention.

As shown in FIG. 2, preferably, the hub body 21 is formed to maintainthe angle A between the first extension tube 26 and the second extensiontube 28 at about 15 degrees. This angle is preferred based upon thenecessity for connecting the catheter assembly 10 to the fluid conveyingdevice, e.g., dialysis equipment.

Returning to FIG. 1, the hub assembly 20 further includes a firstconnector 30 and a second connector 32. The connectors 30, 32 may beluer fittings, as are known in the art. The first connector 30 issecurely attached to the distal portion of the first extension tube 26 band the second connector 32 is securely attached to the distal portionof the second extension tube 28 b. Each of the connectors 30, 32preferably is attachable to a fluid conveying device (not shown), suchas dialysis equipment, as is known in the art. Thus, the respectivecannulae 22 and 24 are in fluid communication with extension tubes 26and 28, respectively. Therefore, the cannulae 22, 24 provide forrespective in-flow and out-flow operation of the fluid conveying device.

Each extension tube 26 and 28 has a clamp, 42 and 44, respectively, forclamping the extension tubes 26 and 28 when the catheter assembly 10 isnot connected to a fluid conveying device.

The hub body 21 has two suture wings 38 and 40, which can be used tosuture the catheter assembly 10 to the patient to maintain the positionof the catheter assembly 10 after insertion into the patient.

As shown in FIG. 3, the hub assembly 20 preferably is formed such thateach proximal end of the cannulae 22 a and 24 a has a generally D-shapedcross-section. Preferably, the distal portion of each of the cannulae 22b and 24 b has a generally O-shaped cross-section. As such, preferably,the proximal portions 26 a and 28 a of each of the extension tubes 26and 28 a have a generally O-shaped cross-section and are configured toreceive the distal portions 22 b and 24 b of the respective first andsecond cannulae 22 and 24. The shape and cross-section configuration ofthe cannulae 22, 24 the extension tubes 26, 28 and the lumens 13, 17 ofthe catheter tube 12, may be varied, and, thus, the scope of the presentinvention should not be limited to the above-described preferredconfiguration.

Preferably, a hub body 21 is formed around the proximal portions of eachof the extension tubes and the distal portions of each of the cannulae.As illustrated in FIG. 2, the hub body 21 provides for protectionagainst disconnection of the several connections between cannulae 22, 24and extension tubes 26, 28. Further, the hub body 21 provides astructure for connection with the catheter tube 12. More specifically,hub body 21 has a proximal portion 21 aand a distal portion 21 b. Aspreviously mentioned, the hub body 21 is selectively attachable to thedistal portion 12 b of the catheter tube 12 so as to provide fluidcommunication between the respective cannulae 22 and 24 (via proximalportions of the cannula 22 a and 24 a) with the lumens 13 and 17,respectively, of the catheter tube 12, which is discussed in more detailbelow.

As shown in FIG. 5, the catheter tube 12 has a first lumen 13 and secondlumen 17. Each of the first and second lumen 13, 17 has a generallyD-shaped cross-section. A longitudinally extending septum 15 defineseach lumen 13, 17 up through the distal portion of the catheter tube 12b, as shown in FIG. 4. Therefore, each lumen 13, 17 connects to arespective cannula 22, 24 for fluid communication therewith.

Preferably, each lumen 13, 17 of the distal portion 12 b of the cathetertube 12, and the proximal ends 22 a and 24 a of the cannulae 22 and 24are correspondingly marked by an indicator, such as a color, to ensureproper matched correspondence upon connection. To further ensure matchedcorrespondence, preferably tips 14, 16, extension tubes 26, 28 andconnectors 30, 32 follow the same marking pattern. Thus, for example,tip 14, the lumen 13, cannula 22, extension tube 26, and connector 30are marked with a first indicator (e.g., the color blue), while tip 16,lumen 17, cannula 24, extension tube 28, and connector 32 are markedwith a second indicator (e.g., the color red). Thus, the first indicatoris associated with one of the lumens and a second indicator isassociated with the other lumen, such that the first indicator and thesecond indicator define a correspondence between that lumen and anassociated cannula, extension tube, and connector. While the indicatormay be a visual indicator such as color, a selectively attachablemulti-lumen catheter with any indicator, visual, tactile, or otherwise,should be considered within the scope of the invention.

As described above, the invention is described with a preferredembodiment containing two cannulae and a dual-lumen catheter. Thepresent invention should not be limited, however, to this preferredembodiment and other appropriate configurations should be consideredwithin the scope of the present invention. For example, the cathetertube and corresponding cannulae may be a series of concentric tubes ofvarying diameter. Alternatively, the assembly 10 may provide a similarconfiguration to that described hereinabove with three (or more)cannulae and a triple (or more) lumen catheter tube. The preferredembodiment, however, includes two cannulae with a dual-lumen cathetertube.

Preferably, as shown in FIG. 3, the connection between the proximalportions 22 a, 24 a of the cannulae 22, 24 and the lumens 13 and 17 atthe distal portion 12 b of the catheter tube 12 is an overlapping fittedconnection. However, any other appropriate fastening means, such asdetents may be used.

Returning to FIG. 1, an example of a preferred connection between hubbody 21 and catheter tube 12 is shown, which includes a connection cover34 having a proximal portion 34 a and a distal portion 34 b. Connectioncover 34 should fit axially about the distal portion 12 b of thecatheter tube 12. The distal end 34 b of the connection cover 34 isappropriately threaded such that the connection cover 34 is selectivelyattachable to the threaded portion 21 a of the hub body 21 such that thecatheter tube 12 is securely attached to the hub assembly 20. Forexample, as illustrated in FIG. 1, the connection cover 34 may includefemale threads to selectively receive the male threads 21 a formed onhub body 21.

Preferably, the present invention also includes a compression sleeve 36that fits axially about the distal portion 12 b of the catheter tube 12as well as fitting axially about the combined proximal portions 22 a and24 a of the first and second cannulae 22 and 24. Compression sleeve 36preferably is formed of malleable material so as to provide furthercompression about the connection between the cannulae 22 and 24 with themulti-lumen catheter tube 12. The connection cover 34 and thecompression sleeve 36 together create force to prevent inadvertentseparation of the catheter tube 12 from the hub body 21 after insertionof the catheter tube 12 into a patient.

FIG. 6 shows the catheter assembly 10 of the present invention with thehub assembly 20 attached to the catheter tube 12.

A preferred method for inserting into a patient the catheter assembly 10of the present invention requires the following: a multi-lumen cathetertube 12 with, preferably, tapered silicone tips 14, 16, and, as areknown in the art, an introducer needle, multiple tear away sheathdilator introducers, J-flex guidewires, trocars, lock right adapterswith clamps, injection caps, a scalpel, sutures, and adhesive wounddressing. Additionally, the physician should have access to scissors,forceps, needles dish, syringes and gauzes.

FIG. 7 shows a preferred method for insertion of the catheter of thepresent invention into a patient's jugular vein. The method begins withplacing the patient in a position with the patient's head turned to theopposite side of where the jugular vein is to be cannulated. Theanatomical landmark for proper insertion is defined by the triangleformed by the lateral edge of the sternal head, the medial edge of theclavicular head of the sternocleidomastoid muscle, and the upper edge ofthe clavicle.

The patient's neck and a portion of the patient's thorax beneath theclavicle, preferably at least about 20 centimeters (cm), should beappropriately prepared for incision. Thereafter, the patient should bedraped and local anesthetic should be administered.

Preferably, a skin wheel should be created, taking care to infiltratethe subcutaneous tissue for about 2 to 3 cm. Next, preferably with an18-gauge needle attached to a syringe, the physician should identify theinternal jugular vein by aspiration and then proceed at an angle whilecontinuing to aspirate with the syringe. Once the internal jugular veinhas been located, the preferred method includes detaching the syringewhile leaving the needle in place. The needle opening should then beocclused and thereafter the J-flex guidewire should be introducedthrough the needle and into the internal jugular vein. The guidewireshould pass without resistance into the exact position. The needleshould be removed, thus leaving the guidewire in place. The guidewireshould rest at the junction of the superior vena cava and the rightatrium. Appropriate guidewire placement can be confirmed withfluoroscopy.

Next, with a scalpel, the physician should make an incision in the skinthat is wide enough for the catheter tube 12 to pass (step 71). Atearaway sheath dilator may be introduced over the guidewire and intothe vein far enough to dilate the vessel. After expanding the vein wall,the guidewire may be removed while occluding the dilator opening. Atrocar should be screwed onto the catheter tube 12 by turning the trocarclockwise, but not the catheter tube 12. Turning the catheter tube 12may cause it to kink. The dilator may be removed, leaving the tearawaysheath in place to introduce the catheter tube 12 (step 72), again beingcareful to occlude the sheath opening. As the catheter tube 12 is fedinto the sheath the tearaway sheath may be torn away. Care should betaken that the catheter tube 12 does not back out of the vessel.

Air embolus is avoided by the patient's positioning described above, andalso by asking the patient to inhale deeply and then hold their breath.At this point, fluoroscopy should be performed to confirm catheter tube12 placement. The tip 14 of the venus catheter should reach the openingof the right atrium and the tip 16 of the arterial catheter should beapproximately 4 cm higher. As described above, proper positioning isimportant. Positioning, as described, is believed to prevent bloodrecirculation during hemodialysis.

Next, a tunnel, of about 8 to 10 cm, should be created (step 73) in acaudal and internal direction by means of the tunneler, which may beshaped to physician preference. The catheter tube 12 should be gentlypulled through the tunnel (step 74) until the loop at the originalpuncture site is gone. When correctly inserted, the catheter tube 12should rest over the clavicle. Care should be taken to avoid excessiveforce, as this may cause the catheter tube 12 to separate from thetunnel. Preferably, the method includes surveying this area to ensurethere are no kinks in the catheter tube 12 and there is a smooth turn.

Next, while pinching the distal portion 12 b of the catheter tube 12,the hub assembly 20 is attached to the catheter tube 12 (step 75). Theconnector 34 is backfit over the catheter tube 12. Next, the compressionsleeve 36 is backfit over the catheter tube 12. The proximal portions 22a, 24 a of cannulae 22, 24 are inserted into lumens 13 and 17,respectively, creating a friction fit. Preferably, the cannulae 22, 24,or the corresponding extension tubes 26, 28 or the correspondingconnectors 30, 32 are marked so that the cannulae 22, 24 are insertedinto the correct lumens 13, 17.

After backfiting the connector cover 34 and the compression sleeve 36over the catheter tube 12, the compression sleeve 36 is slid into aposition that is approximately adjacent to the threaded portion 21 a ofthe hub body 21. Finally, the connector cover 34 is attached to the hubbody 21 (step 76) by turning the connector cover 34 so that the femalethreaded portion of the connector cover 34 receives the male threadedportion 21 a of the hub body 21 thereby creating a secure attachment ofthe hub assembly 20 to the catheter tube 12. Clamps 42, 44 may be usedwith extension tubes 26, 28.

The extension tubes 26, 28 should be filled with 3 to 4 cc of 5000 unitsof heperinized saline, clamped, and attached with the injection cap.X-rays should again be performed to reconfirm placement. The smallincision is closed with sutures. The patient is now ready for dialysis.

As can be appreciated by those skilled in the art, variations in thesequence of the steps are within the scope of the invention. Forexample, the subcutaneous tunnel could be created prior to inserting thecatheter into the area to be catheterized. Also, the incision near thearea to be catheterized can be made prior to routing the catheter tubethrough the tunnel, and the catheter tube can be routed through thesubcutaneous tunnel prior to inserting the catheter in the area to becatheterized.

Although specific embodiments of the present invention have beenillustrated and described in detail, it is to be expressly understoodthat the invention is not limited thereto. The above detaileddescription of the embodiment is provided for example only and shouldnot be construed as constituting any limitation of the invention.Modifications will be obvious to those skilled in the art, and allmodifications that do not depart from the spirit of the invention areintended to be included within the scope of the appended claims. Also,as is known in the art, the terms “distal” and “proximal” are relativeterms with respect to a point of reference. For purposes of theforegoing detailed description of the invention, the point of referenceis the area to be catheterized.

1. A method for inserting a multi-lumen hemodialysis catheter assembly into an area to be catheterized, the multi-lumen hemodialysis catheter assembly having (a) a multi-lumen catheter tube having a distal portion and a proximal portion, and (b) extension tubes each having a proximal end and a distal end, the proximal end selectively attachable to the distal portion of the multi-lumen catheter tube, the method comprising the steps of: making an insertion incision near the area to be catheterized; inserting the proximal portion of the multi-lumen catheter tube into the area to be catheterized; creating a subcutaneous tunnel having a first end and a second end, wherein the first end of the subcutaneous tunnel is near said insertion incision; routing the distal portion of the catheter tube through the subcutaneous tunnel beginning at the first end and exiting through the second end of the subcutaneous tunnel; subsequent to routing the distal portion of the catheter tube through the subcutaneous tunnel, attaching the proximal end of each extension tube to the distal portion of the catheter tube; and attaching the distal end of each extension tube to a hemodialysis fluid circulation device.
 2. The method of claim 1, the catheter tube having at least a first lumen and a second lumen, the proximal end of each extension tube comprising a cannula, each of the cannula having a proximal portion and a distal portion, wherein the step of attaching the proximal end of each extension tube to the distal portion of the catheter tube further comprising of the step of: inserting the proximal portion of each cannula into each of the first lumen and second lumen at the distal portion of the catheter tube to create fluid communication between each cannula and the first lumen and the second lumen.
 3. The method of claim 2, the first lumen having a first indicator associated therewith, and the second lumen having a second indicator associated therewith, wherein the step of inserting the cannula into the lumens further comprising the steps of: matching the first indicator associated with the first lumen with an indicator associated with one of the cannula; and matching the second indicator associated with the second lumen with an indicator associated with the other cannula.
 4. The method of claim 1 further comprising of the steps of: engaging a clamp engaged with each extension tube to prevent fluid flow therethrough; and disengaging the clamp to allow fluid from through each extension tube.
 5. The method of claim 1, wherein the step of attaching the proximal end of each extension tube to the distal portion of the catheter tube is preceded by: gripping the proximal end of each extension tube by a gripping portion sized such that fingers may grip and manipulate the proximal end of the extension tubes.
 6. The method of claim 1, a connector attached to the distal end of each connection tube to ease the step of attaching the distal end of each extension tube to a hemodialysis fluid circulation device.
 7. A method for inserting a multi-lumen hemodialysis catheter assembly into an area to be catheterized, wherein the multi-lumen hemodialysis catheter assembly is comprised of (a) a multi-lumen catheter tube with a distal portion and a proximal portion, the catheter tube having a first lumen and a second lumen, (b) a first and second extension tube each having at a proximal end thereof a cannula, each of the cannula having a proximal portion and a distal portion, the method comprising the steps of: making an insertion incision near the area to be catheterized; inserting the proximal portion of the multi-lumen catheter tube into the area to be catheterized; creating a subcutaneous tunnel having a first end and a second end, wherein the first end of the subcutaneous tunnel is near the insertion incision; routing the distal portion of the catheter tube through the subcutaneous tunnel beginning at the first end and exiting through the second end of the subcutaneous tunnel; subsequent to routing the distal portion of the catheter tube through the subcutaneous tunnel, attaching the proximal portion of each cannula to the distal portion of the catheter tube; and attaching a distal end of each extension tube to a hemodialysis fluid circulation device.
 8. The method of claim 7 further comprising of the steps of: engaging a clamp disposed about the extension tube to prevent fluid flow therethrough; and disengaging the clamp to allow fluid flow through the extension tube.
 9. The method of claim 7, wherein the step of attaching the cannula of each extension tube to the distal portion of the catheter tube is preceded by: gripping the first end of each extension tube by a gripping portion sized such that a fingers may grip and manipulate the cannula of each extension tubes.
 10. The method of claim 7, further comprising a connector attached to each extension tube distal end.
 11. The method of claim 7 wherein the step of attaching the cannula to the catheter tube further comprising of the steps of: inserting the proximal portion of the cannula of the first attachable extension tube into the first lumen of the distal portion of the catheter tube, and inserting the proximal portion of the cannula of the second attachable extension tube into the second lumen of the distal portion of the catheter tube, to create fluid communication between the cannula of the first extension tube and the first lumen and the cannula of the second extension tube and the second lumen.
 12. A method for inserting a multi-lumen hemodialysis catheter assembly into an area to be catheterized, wherein the multi-lumen hemodialysis catheter assembly is comprised of (a) a multi-lumen catheter tube with a distal portion and a proximal portion, the catheter tube having at least a first lumen and a second lumen, (b) an attachable hub assembly, the hub assembly having (i) a hub body being formed about a first cannula and a second cannula, each cannula having a proximal portion and a distal portion, (ii) a first extension tube attached to the distal portion of the first cannula in fluid communication therewith and a second extension tube attached to the distal portion of the second cannula in fluid communication therewith, the first lumen and the first extension tube having a first indicator associated therewith, the second lumen and the second extension tube having a second indicator associated therewith, the second indicator being easily distinguishable from the first indicator; the method comprising the steps of: making an insertion incision near the area to be catheterized; inserting the proximal portion of the multi-lumen catheter tube into the area to be catheterized; creating a subcutaneous tunnel having a first end and a second end, wherein the first end of the subcutaneous tunnel is near the insertion incision; routing the distal portion of the catheter tube through the subcutaneous tunnel beginning at the first end and exiting through the second end of the subcutaneous tunnel; matching the indicator associated with each lumen with the corresponding indicator associated with each extension tube; and attaching the proximal portion of the cannula to the distal portion of the catheter tube.
 13. The method of claim 12 further comprising of the steps of: engaging a clamp disposed about the extension tube to prevent fluid flow therethrough; and disengaging the clamp to allow fluid flow through the extension tube.
 14. The method of claim 12, wherein the step of attaching the proximal portion of each cannula to the distal portion of the catheter tube is preceded by the step of: gripping the first end of each extension tube by a gripping portion sized such that a typical persons finger could grip and easily manipulate the cannula of each extension tube.
 15. The method of claim 12, wherein each extension tube has a distal end, the step of attaching the proximal portion of each cannula to the distal portion of the catheter tube is followed by the step of: connecting the distal end of each extension tube to a fluid circulation device. 